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Step 2 > Psych and Neuro > Flashcards

Psych and Neuro Flashcards

1
Q

Effects and tx

Extrapyrimadial side effect tx

NMS tx

Serotonin syndrome tx

A

EPS - Benztropine, DIphenhydramien

NMS - Rigidity Daltrolene, D2 agonist

Serotonin - - clonus - Cyproheptadine

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2
Q

metoclopramide

odansetron

mech?

A

Met - D2 block

Odansetron - S block

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3
Q

HTN crisis tx? (MAO)

A

pHENTOLAMINE , NIFEDIPOINE

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4
Q

Brief Psychotic Disorder

Delusional Disorder

A

Brief - Less tahn 1 mo - stress related usu

DelusionD - 1+ mo. Functionally not impaired

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5
Q 
Schioaffective
Schizophreniform
schizophrenia
Schizoid
Schizotypal
A 
Schioaffective - 2wk+ w/ mood 
Schizophreniform - 1-6mo
schizophrenia - 6+ mo. DEC dendritic branches. Assoc /w weed in teenagers
Schizoid - voluntarily distancing 
Schizotypal - maginal thinking
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6
Q

Bipolar 1
Bipolar 2
Cyclothymic

A

Bipolar 1 - 1+ mo
Bipolar 2 hypomanic + depressive
Cyclothymic - 2 y hypomanic + dysthymia

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7
Q

MDD

Dysthymia

A

MDD - 2+ - single episode = SSRi for 6mo

Dysthymia - 2y mild depression

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8
Q

Panic disodrer
GAD
Adjustment disorder

A

Panic disodrer - 1mo + - Tx Benzo. Long term SSRI, CBT

GAD - 6+ mo no identifiable stressors - SSRI, CBT

Adjustment disorder - within 6 mo - Identifiable - Tx - Psychotherapy, CBT

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9
Q

Acute Stress Duisorder

PTSD

A

ASD - 3d - 1mo

PTSD 1mo+

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10
Q

Paranoid
Schizoid
Schizotypal

A

Paranoid - projection
Schizoid - voluntary distancing
Schizotypal - magical thinking

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11
Q

Antisocial
boderline
Histrionic
narcissistic

A

Antisocial - 18+. Conduct disrdoer by 15 req.

Boderline - Interpersonal relationship , self harm, splitting

Histrionic - Appearance, sexuality

narcissistic - Demans best. Criticism with rage

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12
Q

Avoidant
O/C
Dependent

A

Avoidant - desires relationship, hypersentiviet to rejection

O/C- does not realize odd perfectionist way

Dependent - subsmissive, low confidence

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13
Q

Social phobia

Specific phobia

A

Social phobia - SSRI, Performance issues = BB

Specific phobia - Behavior therapy

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14
Q

Conversion

somatic

Factitious

malingering

A

Conversion - neuro sign - weakness, blidness, etc Aware but indifferent.

Somatic - somatic

Factitious -Sick role only

malingering - secondary gain.

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15
Q

Brain met - tx?

A

Single met - surgery

Multiple mets - Whole brain RTx

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16
Q

Adult Brain tumors

GBM
Hemangioblastoma
meningioma
oligodendroglioma
pituitary adenoam
schwannoma
A

Adult Brain tumors

GBM - Pseudopalasing, central necrosis, hemoarrhage

Hemangioblastoma - Cerebellar. VHL. w/ retinal angioams . EPO

meningioma - whorled, psamomma. benign . estrogen rec

oligodendroglioma - Fried egg, clear cytoplasm, calcified, chicken wire. Frontal

pituitary adenoam prlactinoma, bilat temp hemi.

schwannoma - spindle, elongated w/ oval nuclei. S100+ Bilat in NF2

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17
Q

Child brain tumors

Pilocytic astrocytoma
Ependymoma
Craniopharyngioma
Medulloblastoma

A

Pilocytic astrocytoma - Cerebellar/posterior fossa. Rosenthal fibers.

Ependymoma - 4th ventricle. Hydrocephalis. Highly malig

Craniopharyngioma - Ca, Cystic, cholesterol rich, Rathkes. Comes back after resection but BENIGN

Medulloblastoma - Homer Wright rosettes - solid blue, highly malig.. hydrocephalus. Drop mets

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18
Q

Acomm

PCA

Basilar

AICA

PICA

ASA

A

Acomm - saccular, berry anerysm -> SAH

PCA - Contra heminopia w/ macular sparing (MCA)

Basilar - locked in

AICA - CN 7, lateral pontine (facial droop)

PICA - CN 9, 10, 11, dysphagia, lateral medullary

ASA - CN 12 - contra paresis , medial medullary.

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19
Q

Stokres:
Charcot Bouchard

lacunar

basal ganglia

A

Charcot - thalamic - sensory, HTN - HTN

Lacunar - Internal capsule - motor , Negative on CT - HTN

Basal ganglia - contra sensory and motor

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20
Q

Ischemic stroke w/o A fib outside of TPA window tx

W A fib?

A

Aspring indefinitely
If it stroke recurs, add Clopidogrel

W Afib - Anticoagulate.

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21
Q

Pseudotumor dx

A

LP confirms. CSF > 250. MR to rule out central vein thrombosis. 70% have empty sella.

Tx Acetazolamide

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22
Q

MS - Gold standard dx

tx acute ?

A

Dx - MRI - not LP (oligoclonal nont sensitive/specific)

Tx acute w/ IV steroids. Not IVIG . Longerterm - Interferon, IVIG, cyclophosphamide.

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23
Q

Spinal cord compression - presentation

A

Motor and sensory. Decreased rectal tone.

Tx - IV STEROIDS, MRI, neurosurg consult.

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24
Q

Essential tremor
Cerebellar tremor
Parkinsonis tremor

A

Essential - worse w/ action
Cerebellar - worse w/ action + ataxia

Parkinsons - better w/ action

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25
Q

Menieres - etiology and presentation?

A

Inner ear endolymph

Ear fullness, vertigo

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26
Q

Prolonged seizure - damages…?

A

Cortical laminar necrosis

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27
Q

Carbamazapine - tox

Tx

A

Agran, SIADH, hepatotox, SJS

Tx - Trigeminal neuralgia. Complex partial seizures.

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28
Q

Phenytoin side effects?

A

Nystagmus, Gingival hyperplaia. LAD. SJS

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29
Q

Phenobarbital use?

A

DOC neonates. Criglig najar t2 (not as bad one)

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30
Q

Cluser headache prophylaxis?

Acute tx.

A

Verapamil.

Acute tx 100% o2, NOT sumatript

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31
Q

Alzheimer

Picks

parkinsons

Lewy Body

Multisystems Atrophy

A

Alzheimer - DEC ACh. Extraceullar B amyloid. Neurofib tagle (intracellular), Hyperphosph Tau.

Picks - FT - disinhibition. Spherical Tau. Early alzheimer

Parkinsons - DEC Dopa (sub Niag)/Basal ganglia. Lewy body (a synuclein).

Lewy Body - Early dementia, hallucination. Parkinsonism late.

Multisystems Atrophy - Parkinsonims w/ autonomic dysfunction.

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32
Q

Huntintons chemical changes, location, presentation.

A

AD - DEC GABA form caudate/basal ganglia. - Neuronal death via NMDA and glutamate toxicity.

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33
Q

Presentation -
CJD

Pml

A

CJD - Startle myoclonus - B pleated sheats - spike waves on EEG.

PML - ICH - nonenhancing lesions w/o mass effects

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34
Q 
NF1
NF2
SturgeWeber
TS
VHL
A

NF1 - cafe au lait, lisch nodules, optic gliomas/iris hamartomas, Pheos, Chr 17

NF2 - BIlat schannomas, meningioma, NF

SturgeWeber - Port wine, ipsi leptomeningial, Hemangioma,

TS - AD - Angiofibromas, Hamartomas, RHabdomyomas, Angiomyolipomas

VHL - Cavernous hemangiomas, Bilat RCC, Pheos.

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35
Q

Chiari 2

Dandy walker

A

Chiari 2 - cerebellar hernaiation, myelomeningocele, syringomyelia

Dandy Waker - absent Vermis - cystic, 4th

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36
Q

Charcot Marie TOoth - findings

A

AD - myelin defect - MOTOR AND SENSORY - Scoliosis, arcch/feet problem. DEC conduction of neurons.

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37
Q

Werdig Hoffman

Polio

A

WerdigH - AR - floppy baby, anterior horn>

Polio - flaccid paralysis - anterior horn

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38
Q

ALS - dm to? presentation, tx?

A

UMN and LMN. Full sensory.

Tx baclofen, rilouzole

39
Q

Friederichs Ataxia - signs? genetic problem?

A

Friedrech Ataxia - Cerebellar + Spinal findings.

AR - trinucleotide. Chr 9, frataxin. Mitochondrial function. HAMMER TOES. Kyphoscoliosis.

40
Q

Adrenoleukodystrpohy - problem and findings

A

CoA to fatty acid.

Dmg to adrenals, testes, white matter. Adrenal crisis, coma.

41
Q

CNS lymphoma - imaging presenation and dx?

A

Weakly ring enhacning - Dx EBV CSF

42
Q

GBS - CSF findings?

A

Normal cell (normal WBC) and glucose. INC! protein

sensory may be affected as well.

43
Q

Menieres presentation?

BPPV -

Vestibulopathy

A

Ear fullness, tinnitus, horizontal nystagmus

BPPV - Calcium crystals in semicircular canal. BRIEF. No tinitus. Vertigo WITH MOVEMENT.

Vestibulopathy - nystagmus with head thrust (may be aminogylcoside induced)

44
Q

Wernicke

Korsakoff

A

Wernicke - Encephalopathy, oculomotor, ataxia

korsakoff - Konfabulation, Irreversible amnesia, apathy

45
Q

Brain death - what signs remain?

A

No eye reflexes, no breathign drive, no atropine heart reflex.

DTR still intact (spinal cord still works!)

46
Q

Alz vs NPH

A

NPH has gait disturbances firstg and most prominent.

Alz may get ataxia and incontinence later

47
Q

Central cord injury

Anterior Spinal cord injury

A

Central cord injury - Upper extremity> Lower extremity due to placement in cord.

Anterior spinal Cord - Lower > Upper motor, DEC pain and temp. +-bladder and bowel.

DCML fine.

48
Q

Bacterial meningitis tx?

A

STEROIDS (if negative for strep, d/c)

ICH - Vanc, Cefapime, Ampicillin

49
Q

CP presentation

A

Tone, spasticity, MR, Gain, feet abnormality.

Preterm risk factors.

50
Q

Alz tx -

A

Donepezil, Rivastigmine, Galantamine

All anticholinesterase inhibitors

51
Q

Uncal herniation - which CN goes first

A

CN3 first

52
Q

Cluster headaches - presentation

ppx

Tx?

A

Cluster headaches - lacrimination, rhinorrhea, conjunctival injection. No n/v

PPx w/ verapamil

tx - 100% 02, Not sumatriptan

53
Q

Syncope:

Vasovagal

vs

Carotid sinus syncope

A

Vasovagal - clinical dx. If complciated for whatever reason, Upright table tilt.

Carotid sinus syncope - not vasovagal - Hypersenstiivty of carotids. TIGHT COLLAR.

54
Q

Astrocytomas – prognosis

A

based off of GRADE of anaplasia

55
Q

CSF findings of HSV encephalitis

A

– WBC 25, , Glucose normal, RBC ~700+, Protein HIGH

56
Q

BPPV – etiology and tx?

A

Displaced otoliths or Ca crystals in semicircular. Tx is repositioning head xercises (Epley maneuver) to try to reposition displaced otoliths.

57
Q

Migraine tx

A

Triptans, NSaids, Antiemetics, Ergots (Dihydroergotamine). However, do NOT give triptans and Ergots together – can cause prolonged vasospasm.

58
Q

Migraine ppx

A

– Topiramate, Valproic, TCA, BB. (don’t confuse w/ cluster headache pp Verapamil)

59
Q

More than 3/4 hours singe stroke? Tx?

A

Aspirin

60
Q

After stroke, what to start everyone on?

A

Statin

61
Q

Which medication can low progression of parkinsons?

A

MAO inhibitor (Rasagiline)

Levo Amantandine pramipexole etc do not slow.

62
Q

Restless leg syndrome tx?

A

Pramipexole (dopamine agonist)

63
Q

GBS - tx?

Acute Myasthenic Crisis tx?

A

NO STEROIDS

IVIG OR Plasmapheresis - NOT AND.

GBS and Myasthenai both dont take steroids.

ITP has steroids.

64
Q

ADHD - tx?

A

Methylpehnidate, dextroamphetamine

BUT SECOND LINE - ATOMOXETINE - NE reptakei has fewer side effects, less abuse - highly lauded on Step 2 CK

65
Q

Ataxia, dysmetria, nystagmus

A

cerebellar hemorrhage.

66
Q

Contra hemiparesis and sensory loss, upgaze palsy

A

thalamic

67
Q

After stroke give what ppx - Algorith with past strokes, afib etc

A

Aspirin. If on aspirin with stroke, give clopidogrel OR dipyridamole. If with afib, give anticoagulation.

68
Q

Social Anxiety Disorder (Social Phobia)–

A

THIS IS DIFFERENT CATEGORY THAN SPECIFIC PHOBIA. Fear of scrutiny, embarrassment about performance, social situations.

69
Q

Does not respond to Sertraline. What to do

A

Same class SSRI. If fail 2 trials, switch to different class

70
Q

Ataxia, dysmetria, nystagmus

Contra hemiparesis and sensory loss, up gaze palsy

Contralateral hemiparesis and sensor, gaze palsy

A

Ataxia, dysmetria, nystagmus – cerebellar hemorrhage.

Contra hemiparesis and sensory loss, up gaze palsy- thalamic

Contralateral hemiparesis and sensor, gaze palsy - basal ganglia

71
Q

Restless leg tx

A

Pramipexole(dopa ago) or Gabapentin (CC)

72
Q

Parkinson gait?

A

Narrow based, hypokinetic. NOT Broad/wise based gait. Wide base is more cerebellar or sensory ataxia.

73
Q

Absence seizures 2 tx

A

Ethosuximide, valproic.

74
Q

Somatic disorder vs Illness anxiety Disorder

A

Somatic has sx 1 or more. Illness anxiety is worry with minimal/no sx.

75
Q

Location fo Brocas and Wernickes

A

Brocas (frontal lobe), Wernickes (Temporal)

76
Q

neuro/psych drugs assoc w/ pancreatitis?

A

Valproic associated with actue pancreatitis, as are other anti epileptics

77
Q

Acute mania tx of choice –

A

Antipsychotics (Haloperidol as well as risperidone, olanzapine etc). Mood stabiliers Lithium,
Valproate Carbamazepine take longer to kick in.

78
Q

Pseudotumor concerns

A

BLINDNESS. Seizures, bleeds, urinarny incontienc unlikely. May shut or optic nerve seath fenestration to prevent blindness (also why you see papilledema)

79
Q

Sexual assault associated with what risk?

A

PTSD, depression, suicidality. Nicotine and drugs NOT assoc risk.

80
Q

Friedrichs Ataxia vs CP

A

do not mix up! Both have odd feet findings and gait/weaknes sin lower limbs. BUT friedrichs will have heart issues as well.

81
Q

Posterior vermis syndrome

A

– gait, trunk dystaxia!, horizontal nystagmus, papilledema (medulloblastoma

82
Q

Epidural hematoma algorithm

A

emergent craniotomy. Steroids have no role (unlike spinal compression and bacterial meningitis)

83
Q

Fibromyalgia first line

A

TCA, then SSRI

84
Q

Manic breaks and cessation of meds

A

If one, can stop after 1 year. If 2 -> years/lifetime. 3-> lifetime recommended.

85
Q

Imaging findings in autism, OCD, Panic, PTSD, Sschizoprhenia:

A

Autism: INC total brain volume;

OCD: Orbitofrontal cortex and stgriatum;

Panic: Amygdala DEC;

PTSD dec Hippocampal;

Schizophrenia ENLARGEDMENT OF VENTRICLES.

86
Q

Normal protein CSF levels

A

less than 40

87
Q

Classic migraine picture (even in kids) without foacl neuro problems algorithm

A

counsel on migraines and nsaids. Triptains if these don’t work.

88
Q

Tourette tx

A

– Antipsychotuic, clonidine, behavioral therapy. NOT SSRI.

89
Q

Edpitural hematoma what to do

A

emergenct craniotomy for all edidurals.

90
Q

Benzo vs Barbiturates mech?

A

Benzo GABA Cl INC FREQ. Barbiturates Cl INC DURATIOn.

91
Q

Most effective therapy for prevent PTSD after traumatic event?

A

Group counseling

92
Q

Antidepressant with weight loss/fewest sexual side effects

A

Buproprion. Assoc w/ seizures in anorexics.

93
Q

Easiest way to differeniate anorexia from bulimia

A

Anorexia underwegith, bulimia normal weight. Both may have purging hx. Olanzapine great for anorexia (antipsychotic + weight gain)

94
Q

Tx for

anorexia
bulemia
body dysmorphic

A

anorexia - antispychotic (olanzapine)
bulemia - SSRI
body dysmorphic - SSRI/cbt

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